Despite the recent advances in the treatment for HIV/AIDS there remains a significant amount of variability in disease course that may be accounted for by psychosocial and psychobiological processes. This grant requests funding to determine the impact of both psychosocial (stress, coping and related variables) and biological factors (cortisol, Cytotoxic T lymphocytes, and NK#) on disease progression and mortality in HIV/AIDS. The study includes an HIV positive sample that has been followed for 3.5 years: This proposal would add new subjects comparable to the existing cohort and new biological measures and extend follow-up for 5 to 8 years total. At entry our subjects' CD4 counts were between 150 and 500, and they had never had serious AIDS symptoms (Category C). Particular strengths of the study that give this cohort the ability to contribute new information above other cohorts studied to date include (1) Our sample has diverse groups (28% women; 36% African American; 30% Hispanic). (2) The entire study has been conducted during the time protease inhibitors have been available, which makes issues such as adherence of paramount importance. Antiretroviral levels and genotyping will be added to ensure accuracy of adherence measures and to measure the development of resistance. (3) We have been able to quantify some relatively unexplored variables such as the doctor-patient relationship, spirituality, and emotional processing. (4) We are one of the first studies to be able to predict viral load. (5) We include several biological measures that could be investigated as both predictors and as mediators of disease progression. While we have strong cross sectional and longitudinal data showing that psychosocial variables are related to CD4 and viral load changes (controlling for relevant variables), the current long-term longitudinal design should allow us to relate these psychosocial variables to the development of serious AIDS symptoms and mortality. These analyses confirm that we have identified appropriate variables for expanding explorations of psychobiological links. Major strengths of the proposed study are that it will allow us to: (a) predict critical disease end points (e.g. Category C symptoms) and mortality; and (b) relate important psychosocial variables (e.g. stress, depression coping, adherence, doctor-patient relationship) to biological processes and disease endpoints. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH066697-02
Application #
6797823
Study Section
Special Emphasis Panel (ZRG1-AARR-6 (02))
Program Officer
Stoff, David M
Project Start
2003-09-04
Project End
2008-06-30
Budget Start
2004-07-01
Budget End
2005-06-30
Support Year
2
Fiscal Year
2004
Total Cost
$517,312
Indirect Cost
Name
University of Miami Coral Gables
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
625174149
City
Coral Gables
State
FL
Country
United States
Zip Code
33146
Ironson, Gail; Henry, Sarah M; Gonzalez, Brian D (2017) Impact of stressful death or divorce in people with HIV: A prospective examination and the buffering effects of religious coping and social support. J Health Psychol :1359105317726151
Ironson, Gail; Fitch, Calvin; Stuetzle, Rick (2017) Depression and Survival in a 17-Year Longitudinal Study of People With HIV: Moderating Effects of Race and Education. Psychosom Med 79:749-756
Kremer, Heidemarie; Ironson, Gail; Kaplan, Lauren et al. (2015) Spiritual coping predicts CD4-cell preservation and undetectable viral load over four years. AIDS Care 27:71-9
Ironson, G; O'Cleirigh, C; Kumar, M et al. (2015) Psychosocial and Neurohormonal Predictors of HIV Disease Progression (CD4 Cells and Viral Load): A 4 Year Prospective Study. AIDS Behav 19:1388-97
Kremer, Heidemarie; Ironson, Gail (2014) Longitudinal spiritual coping with trauma in people with HIV: implications for health care. AIDS Patient Care STDS 28:144-54
Ruffin, Rachel; Ironson, Gail; Fletcher, May Ann et al. (2012) Health locus of control beliefs and healthy survival with AIDS. Int J Behav Med 19:512-7
Ironson, Gail; Stuetzle, Rick; Ironson, Dale et al. (2011) View of God as benevolent and forgiving or punishing and judgmental predicts HIV disease progression. J Behav Med 34:414-25
Ironson, Gail; Kremer, Heidemarie (2009) Spiritual transformation, psychological well-being, health, and survival in people with HIV. Int J Psychiatry Med 39:263-81
Kremer, Heidemarie; Ironson, Gail; Porr, Martina (2009) Spiritual and mind-body beliefs as barriers and motivators to HIV-treatment decision-making and medication adherence? A qualitative study. AIDS Patient Care STDS 23:127-34
Kremer, H; Ironson, G; Kaplan, L (2009) The fork in the road: HIV as a potential positive turning point and the role of spirituality. AIDS Care 21:368-77

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